Children's Home run by West Sussex County Council in West Sussex

SC067753 Unique reference number 21 August 2009 Inspection date Kevin Whatley Inspector Key Type of Inspection

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This document may be reproduced in whole or in part for non-commercial educational purposes, provided that the information quoted is reproduced without adaptation and the source and date of publication are stated.

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You can obtain copies of The Children Act 2004, Every Child Matters and The National Minimum Standards for Children's Services from: The Stationery Office (TSO) PO Box 29, St Cripins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop

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About this inspection

The purpose of this inspection is to assure children and young people, parents, the public, local authorities and government of the quality and standard of the service provided. The inspection was carried out under the Care Standards Act 2000. This report details the main strengths and any areas for improvement identified during the inspection. The judgements included in the report are made in relation to the outcome for children set out in the Children Act 2004 and relevant National Minimum Standards for the establishment.

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The inspection judgements and what they mean

this aspect of the provision is of exceptionally high quality Outstanding: this aspect of the provision is strong Good: this aspect of the provision is sound Satisfactory: this aspect of the provision is not good enough Inadequate: 3 of 11 Inspection Report: SC067753

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Brief description of the service

The setting is a respite service for children and young people with both physical and learning disabilities. The home is registered for a maximum of 16 young people.

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Brief description of the service

The home is a purpose-built building which offers the young people a wide variety of facilities. The spacious accommodation includes single bedrooms, communal lounges with dining space, soft play areas and a well-equipped sensory room. There are several large bathrooms which provide enough space and the facilities for those requiring personal care or who are physically disabled. Ceiling tracking for hoisting is available in part of the building, ensuring those who are less mobile are included and involved in activities. The home is close to the local town and countryside which can offer the children and young people a wide range of activities based in the community.

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Summary

This key inspection was unannounced taking place on a weekday. Young people have their health care needs met appropriately and receive a suitable diet which takes into account their special dietary needs and personal choices. Young people are protected from the risk of harm as best as possible, with appropriate safeguarding training provided to staff. The individual needs of young people are addressed in an excellent fashion. Appropriate care planning and review procedures highlight all relevant aspects of care. A review is taking place to fully consider how best to assist young people to contribute their views and opinions. Young people live in an environment which is appropriate and wherever possible personalised. One aspect of the premises was still found to pose some health and safety risk despite this being noted in the last two reports. The home is well managed and monitored by an experienced manager and

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Summary

senior staff team. Young people have their challenging behaviours assessed and planned for. However it was found that on occasion the manner in which young people have had their extremely challenging behaviours addressed restricts their liberty contrary to legal procedures; this is therefore inadequate practice. The overall quality rating is inadequate. This is an overview of what the inspector found during the inspection.

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Improvements since the last inspection

No actions were made at the last inspection. Four recommendations were made at the last inspection, two of these have now been met, one has been partially addressed, whilst one remains unmet and hence becomes an action as a result of this inspection.

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Improvements since the last inspection

The duration of physical interventions are now routinely recorded, whilst unpleasant and odorous smells have been eliminated. The need to formalise the process for gaining the views and wishes of young people is currently being considered by way of a comprehensive review.

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Improvements since the last inspection

A recommendation to cover hot water pipes in the bathroom has not been addressed despite being made in two previous inspections and therefore becomes an action.

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Helping children to be healthy

The provision is good. 4 of 11 Inspection Report: SC067753 Young people have their dietary needs taken into consideration when the daily menus are planned. The types of foods which young people like and dislike are recorded, whilst special diets are provided to those who may have food allergies, intolerance to certain edibles or diabetes. Those young people who wish to have meals which match their chosen religion or faith have these provided. The predominantly respite nature of the setting means that many different young people eat on different days. The cook in charge of catering has worked at the home for many years and clearly understands and knows the diets of all young people accessing the service. The menu showed a reasonable variety of meals with a balance of vegetables and produce. The catering department has just been awarded a high grade when passing a recent environmental health inspection.

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Helping children to be healthy

Detailed and comprehensive health plans are in use which ensure the health and welfare needs of each young person are carefully identified and promoted. For young people on longer stay programmes the health care plan provides a consistent and comprehensive guide for staff to review the needs of each particular young person. Clear liaison is kept between the Looked After Child (LAC) nurse with all required appointments and medicals being planned for and facilitated with staff assisting young people to attend when necessary. Those young people who access respite care have a majority of their routine medical needs met by their parents or carers.

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Helping children to be healthy

Where specialist intervention is required to address specific emotional or mental health issues staff provide positive and pro-active support to the young people. Close working links are maintained between specialist health care professionals and the setting to ensure a joined up approach in addressing intervention strategies or intensive programmes of care. When required multi-agency reviews or strategy meetings are convened and can include the creating of a 'team around the child' ethos thus allowing for more intensive, consistent and focused support and guidance for the young person concerned.

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Helping children to be healthy

Robust medication storage and administration procedures ensure young people have their medicines stored and given safely. The procedures are comprehensive with only senior staff on duty being able to administer medication once they have been assessed as competent to do so. All medicines are stored in a specifically facilitated room with appropriate storage space. Stock records are kept of homely medicines which are regularly monitored; one minor error was noted whereby staff had taken a headache tablet for themselves but had not written this in the stock record. Records of prescribed medication are kept accurately and up to date. Parents and carers sign consent for the giving of medicines, first aid and emergency treatment.

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Protecting children from harm or neglect and helping them stay safe

The provision is inadequate. Young people have their privacy appropriately protected with any personal care needs being provided in a sensitive and thoughtful manner. All confidential information is stored securely.

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Protecting children from harm or neglect and helping them stay safe

A clear complaints procedure is in place with details being provided to parents and carers. Young people have their own version which has been completed using different communication methods such as pictorial, symbols or specific word formats. Very few complaints have been made since the last inspection, these have been addressed swiftly and comprehensively with clear outcomes for all concerned. No complaints have been made to Ofsted since the last inspection. 5 of 11 Inspection Report: SC067753 A rigorous approach toward child protection ensures that staff are fully aware of how to keep young people as safe as possible. All staff receive child safeguarding training with routine refresher and advanced courses being provided. All procedures have been produced in line with the local safeguarding board's guidance and protocols. A robust recruitment process ensures no members of staff work with young people until all the required checks and references have

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Protecting children from harm or neglect and helping them stay safe

been confirmed. Staff files are predominantly maintained at head office although working files are kept on site which provide good evidence of recruitment; however, those held at the home do not yet contain a photographic identification.

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Protecting children from harm or neglect and helping them stay safe

Suitable procedures are in place to respond to absconding behaviour. Comprehensive details of each young person’s vulnerability in the event that they leave the home without permission are recorded. Absconding incidents seldom occur with no significant issues noted since the inspection.

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Protecting children from harm or neglect and helping them stay safe

Incidents involving bullying are fairly rare with comprehensive assessments addressing all aspects of each young person's challenging behaviour. The nature of the setting means that a key aspect of all risk assessments revolve around the manner in which each young person expresses and communicates their frustration, anger, displeasure or agreement. The use of punitive sanctions are virtually nil with any sanctions imposed used being appropriate and relating to the particular young person's abilities and levels of comprehension. Staff are trained in the use of physical intervention with clear recording and monitoring procedures in place.

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Protecting children from harm or neglect and helping them stay safe

When those young people who are living at the home long term display consistently difficult and challenging behaviours, specific behaviour management plans are put in place. When necessary all key persons involved in that particular young person's care, such as parents and other care professionals meet to plan and agree intervention strategies. For instance, utilising the skills of the 'team teach' trainer in conjunction with staff working with the young person in question to find safe and consistent ways to de-escalate or manage aggressive, violent or risky situations. Similarly gaining expert advice from specialists in the field of autism or learning disabilities to aid communication and assessment of behaviour. Specific records are maintained of the particularly challenging behaviours of young people, however, one record had not been kept up to date.

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Protecting children from harm or neglect and helping them stay safe

Records of interventions show that since the last inspection a majority of the restraints relate to the behaviours of the same few young people who have particular difficulties managing their own behaviours and outbursts. A number of strategies have been implemented in these circumstances including the development of soft play rooms near to living areas to allow those young people to gain space, calm down and relax. However, such records also note that at times when young people exhibit extreme and uncontrolled violence and risk, such as banging their heads against walls, that staff had bolted a soft room door shut with a young person inside to ensure the safety of all. On several other occasions staff had used a wedge to secure the corridor doors to limit the young person's access to others. The strategy to use such a restriction of liberty was sanctioned by parents, the placing authority and other care

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Protecting children from harm or neglect and helping them stay safe

professionals. There is no question that during these situations a large number of staff were in attendance to assist, monitor and ensure the wellbeing of the young person concerned. Although such practice was only applied at times when the risk of harm or injury to the young person or others was deemed extreme, the number of similar situations when these such restrictions were implemented suggests this was a planned response. Therefore despite such restrictions seemingly being enforced as a safeguarding measure there are no legal grounds 6 of 11 Inspection Report: SC067753 for this to occur. Immediate actions were subsequently taken by the Registered Manager to stop this practice with the relevant behaviour management plan and risk assessment being amended.

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Protecting children from harm or neglect and helping them stay safe

All those who live and work in the setting are generally protected by comprehensive Health and Safety procedures. The routine servicing and testing of gas and electric appliances occur whilst all fire fighting equipment is regularly tested. Fire drills take place within appropriate timescales, however, no recent drill has involved the young people. On touring the building it became apparent that a bathroom still had exposed hot water pipes; this was noted in the last inspection report.

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Helping children achieve well and enjoy what they do

The provision is outstanding. Young people have their particular needs met in an excellent fashion with consistently high levels of individual support being provided. Key working is a fundamental aspect of the service with young people clearly considered in the process. Young people on longer term placements are cared for by the same full time staff with intensive programmes of care ensuring the young person in question is looked after with continuity. Every effort is made to ensure young people accessing short respite periods of care also receive a consistent care approach with the same key staff on duty when they are in. When this is not possible clear methods of communication ensure young people receive the same standard of care and input. Staff display considerable understanding of each young person's physical, medical and social care needs with a notable focus on their emotional well being and how they communicate their needs.

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Helping children achieve well and enjoy what they do

Routine child focus meetings review the individual progress of each young person with comprehensive care planning responding to changing needs and circumstance. When required joined up working processes ensure that all parties concerning the particular young person are brought together to facilitate 'team around the child' strategy meetings. Regular key worker reports provide a detailed overview of each young person's progress.

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Helping children achieve well and enjoy what they do

A positive learning culture encourages young people to engage in their education. Each young person has a personal education plan that clearly defines the type of programme they should be receiving. On occasion staff have provided short term in-house support to young people who may not be in receipt of statutory education. Such an approach is only ever taken under the guidance of the Local Education Authority. Staff work hard to maintain clear and open communication between themselves and the various schools and colleges, for instance, by using communication books. Liaison with the nearby school is particularly good.

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Helping children achieve well and enjoy what they do

The day to day running of the home encourages young people to engage in activities; wherever possible this includes their personal choices and wishes. Regular trips are made to local places of interest such as the cinema, shopping or trips to leisure centres and specialised activity facilities. The culture within the home promotes integration with the local community with staff readily engaging young people with visits to local fetes, shows and festivals.

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Helping children make a positive contribution

The provision is good. Young people benefit from detailed placement plans which ensure their needs are known, assessed and planned for. Care plans outline how each young person will have their welfare 7 of 11 Inspection Report: SC067753 needs met and where necessary have these addressed in line with the overall LAC placement plan. Carefully completed assessments focus on all key aspects of each young person's physical, emotional and social care needs thus ensuring they are appropriately placed at the home.

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Helping children make a positive contribution

A good system of care plan reviews is in place ensuring that the changing needs of each young person are taken into account. Key-workers complete monthly reports which provide a very good overview of the progress of each young person against their individual care plans. Of the care plans sampled not all were found to have up to date in house reviews. Key-workers contribute to the preparation of statutory LAC reviews when required.

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Helping children make a positive contribution

Staff support and encourage young people in their contact with parents and carers. As a predominantly respite service most young people maintain extremely regular contact with their parents and carers, living for the majority of time with them at home. When necessary specific contact arrangements are managed in accordance with the LAC placement plan.

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Helping children make a positive contribution

It is clear that young people are listened to by staff and have their views and opinions considered. Young people are encouraged to express their views and to contribute to the day to day running of the home. Since the last inspection staff have worked with young people to put up posters which covey the Every Child Matters outcomes. For instance, for being healthy young people are pictured participating in games and physical activities, whilst for positive contribution the idea of helping each other around the home and recycling rubbish at the community tip was presented. However, there is still no consistent approach to recording and monitoring how consultation and engagement is achieved. The Registered Manager stated that two senior members of staff have been delegated the task of reviewing the process of consultation across the whole setting including care planning, reviews and young person's meetings.

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Achieving economic wellbeing

The provision is satisfactory. Appropriate procedures and practices are in place to support young people as they approach adulthood. A majority of young people remain living at home with their parents and carers once their ages dictate they can no longer access respite care at the setting. Therefore, the nature of the service means the need for pathway planning is limited. No young people are currently at an age where they are in the process of moving on or leaving care. Clear working practices such as developing life skills programmes are available as when they are required to be implemented.

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Achieving economic wellbeing

The home is a purpose built property with all living accommodation provided on the ground floor. A large part of the setting is open plan with separate lounge areas provided around the home; some areas can be sectioned off to ensure more privacy and quiet when needed. The nature and size of the environment means that some of the décor and furnishings appear functional. Nevertheless wherever possible personal touches have been implemented to make bedrooms more individual, notably for those young people living at the home long term. Young people in receipt of continuing care have their own living areas which have been developed solely with them in mind. Communal areas have been enhanced with posters with young people assisting to create some vibrant and interesting pieces of art work and murals.

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Achieving economic wellbeing

The building consists of two wings one of which has been designed to accommodate those young people with physical disabilities. This area has specialised facilities including electric hoists and purpose designed bath and showers. Where necessary bedrooms have been fitted 8 of 11 Inspection Report: SC067753 out to meet the individual needs of young people. Bedrooms where young people would pull down curtains or blinds have had laminated strips fitted to their windows to ensure their privacy.

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Achieving economic wellbeing

The home has six communal areas. These consist of three lounges, one computer area, one soft play area, one ball pool room and a sensory room. Each of the areas is equipped to meet the specific needs of the children and is in good condition and working order. The lounges are complete with soft furnishings, pictures and paintings.

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Achieving economic wellbeing

The house has a large garden which is predominantly set to tarmac with a soft base built around play equipment. A large set of railings cuts across the garden to ensure young people are able to enjoy separate areas; although somewhat unsightly it serves it's purpose.

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Achieving economic wellbeing

The building is kept in a reasonable condition both inside and out although as stated previously one bathroom was found to have exposed hot water pipes which has been noted in the last two inspection reports.

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Achieving economic wellbeing

The home is kept clean and hygienic with no obvious smells or unpleasant odours.

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Organisation

The organisation is inadequate. A good level of information is made available which describes the setting and the services it offers. This includes a clear overview of the types of care provided at the home namely a predominant respite service but one which can also offer medium and longer term placements. A young person's guide has been produced which offers a more user friendly pictorial format. A regular newsletter is sent out to parents, carers and young people to ensure they are kept informed of matters within the home.

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Organisation

The promotion of equality and diversity is good. In particular young people have their wishes acknowledged in respect of food choices and include the provision of meals which respect their religion or faith. Young people are cared for by a good mix of staff with gender balances being considered wherever possible. It is clear young people have their individual needs met very well and are listened to accordingly; a study is currently underway to improve this further. The largely open plan environment does not always lend itself easily to the needs of all young people, however staff work hard to try and provide suitable spaces for those who require quieter and calmer areas. The management approach of the home promotes the needs of young people as paramount.

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Organisation

Staffing numbers within the home are adequate to meet the needs of young people during the day and night. The recent opening of a small specialised service within the organisation has seen some staff take the opportunity to move to that setting. This has seen the home experience a transitional period with new staff being employed; approximately two full time posts remain unfilled though interviews are on going. Staff have subsequently been moved around the different teams to ensure an appropriate mix of experience and skills across the home. There is still some reliance on agency staffing, although this has lessoned since the last inspection. Wherever possible only temporary staff who have previously worked at the home are deployed.

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Organisation

Staff receive good training opportunities and have to complete a focused induction programme which is now linked to current qualification and pathway training requirements. Records of staff training show that all key and compulsory courses are provided with opportunities for 9 of 11 Inspection Report: SC067753 staff to pursue additional relevant qualifications. Staff receive very good and consistent support, guidance and leadership from the Registered Manager and the senior management team. Formal supervision occurs regularly with staff stating they feel suitably supported in carrying out their tasks.

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Organisation

All areas of care provision are clearly monitored and reviewed with routine checks being carried out by the Registered Manager or via delegation to senior staff. Records of monthly checks are kept being compiled within an objective framework. The required monthly Regulation 33 inspection visits are completed appropriately.

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Organisation

Since the last inspection the organisation commissioned an independent survey of all the children's disabilities services it operates, including this setting. The report focused on the views of staff, other care professionals, parents and carers and young people themselves. In particular parents and carers noted how well they felt young people were cared for and how they were all involved in care planning and review with clear and obvious communication. In general the survey was very positive and provided an extremely useful quality assurance process.

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Organisation

Records required to be kept generally evidenced the progress and development of young people. However, as previously noted a review and behaviour monitoring log had not been kept up to date.

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Organisation

The Registered Manager is extremely experienced and clearly understands every aspect of the home and the needs of those who live and work in it. Whilst acknowledging the restriction of liberty was used as a safeguarding measure and with the consent of the placing authority, parents and other care professionals, it is nonetheless unacceptable.

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Statutory requirements

This section sets out the actions, which must be taken so that the registered person meets the Care Standards Act 2000, The Childrens Homes Regulations 2001 and the National Minimum Standards. The Registered Provider must comply with the given timescales.

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Due date Action Standard

24 September 2009 ensure all areas of the home are kept safe and free from hazards, in particular that the exposed hot water pipes in the bathroom are covered in accordance with Regulation 23 (a) 24 August 2009 ensure doors are not locked to restrict the liberty of young people living at the home in accordance with Regulation 17 (a) (b)

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Recommendations

To improve the quality and standards of care further the registered person should take account of the following recommendation(s): • ensure staff record in the homely medicines stock record when they have taken headache tablets for their own use (NMS 13.10) • ensure staff files kept on site contain picture identification (NMS 27.1) 10 of 11 Inspection Report: SC067753 • ensure fire drills involve young people living at the home, notably those on longer term placements (NMS 26.8) • implement a format for gaining the views, wishes and opinions of young people who are able to contribute to decisions made about the setting and the services it offers them (NMS 8.8) • ensure documentation such as monthly care plan reviews and behaviour management monitoring logs are completed and kept up to date (NMS 35.2) 11 of 11 Inspection Report: SC067753

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